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The purpose of this study is to examine changes in the nature, form and range of commissioning arrangements for home care.

Data from two discrete national surveys of English local authorities with social service responsibilities were used. In the first, undertaken in 2007, responses from 111 of the 151 local authorities (74%) were received; in the second, undertaken in 2017, responses from 109 local authorities (72%) were received. A combined data set of 79 complete cases, 52% of local authorities, was created. Percentage point differences across the two time periods were calculated and tested to identify significant changes and a systematic analysis of the free-text responses regarding intended changes to the commissioning process in each data set was undertaken.

Findings identified substantial changes in some aspects of the commissioning of home care in the 2007-2017 decade. Collaboration between stakeholders had increased, particularly regarding the identification of future needs. Improved conditions of service and remuneration for home care workers were evident within the commissioning process. Standardised charges for home care (regardless of time and day) had also become more widespread. Initiatives to prompt providers to deliver more personalised care were more evident.

This paper describes the evolution of commissioning arrangements for home care in localities in response to national policy initiatives. It provides guidance to commissioners in meeting the needs of current service users and emphasises the importance of collaboration with stakeholders, particularly providers, in securing future capacity.

This paper aims to present a case study of the Manchester metropolitan area's efforts at implementing a regional approach to economic policy making and metropolitan governance. Vis‐à‐vis an emerging proposal for a concerted and effective approach towards the development of a governance model for the Manchester City Region, the paper aims to discuss the competing proposals for a mayoral and more “federalist” model of coordinating local policies in the area..

The paper examines the roles of different agencies – business representations and local authorities – in working towards a form of coherent governance for the city region against the backdrop of the many current precedents of such arrangements across Europe.

The paper finds that local authorities in the Greater Manchester area tend to favour a federalist City Region approach with greater autonomy for each participating local government. Yet, the alternative mayoral model retains the advantage of a distinct identity and direct accountability. In any case, a strong and coherent private sector input on key issues affecting the economy and its development in the Manchester City Region are required, but, as yet, not always sufficiently articulated.

Finding an “appropriate” model of city‐regional governance is a very topical issue. The contribution of this paper is thus timely and offers a good insight into the practical side of coordinating public and private sector interests and ways of making policies as part of city‐regional governance.

MANCHESTER, like most of our provincial cities, is undergoing a transformation as its grimy Victorian buildings crumble beneath the demolition squads. In their place rise faceless blocks of offices and shops, whose glass and concrete soon lose their early gleam and smoothness and become streaked and shabby. They do not mature with the same charm as the brickwork and the carved and moulded stonework of the buildings they replace, for in spite of its reputation for ugliness and the accepted view of a drab city of umbrella‐carrying citizens and shawl‐clad and clog‐footed millworkers, there was an aura of romance about the older Manchester, something that prompted a man who was not a native of the city, Howard Spring, to write:

Over the last five years, governments, think‐tanks and public alike have re‐focused their minds on the future development of British cities. Why are such diverse social organizations producing visions of urban futures? What kinds of techniques and tools are they using, and what are their implications? What types of city do they envision? And most significantly, what are the resonances and dissonances between the development paths they propose?

The purpose of this paper is to describe the findings from an electronic questionnaire survey which set out to explore experiences of graduates of a part-time Master’s programme in dementia care at The University of Manchester.

An electronic questionnaire survey was sent to 57 graduates who had studied on the programme since it began in 2003. Thematic analysis was applied to qualitative data from responses to six open-ended questions.

In total, 31 completed questionnaires were received. Four key themes were identified from the qualitative data: juggling competing demands; experiencing personal growth and achievement; locating sources of support; and supporting changes to practice.

Limitations included the small sample size and the survey not covering the experiences of students who had failed to complete the first year of study.

The study demonstrates the perceived value of dementia education at more advanced levels for people working in professional roles in dementia care, this included professional and personal development and supporting changes to practice. The study additionally adds to a limited evidence base relating to how mature, health and social care students experience part-time study in higher education and has implications for future research aimed at informing the development of appropriate course design and employer support.

This chapter builds upon the analysis of the last chapter, as fans have to deal with the issues that arise from their team’s financial superiority. Here, we question what happens when that financial superiority is accompanied by significant moral and ethical issues. Recent involvement of state actors in the ownership of English football has been evidencable and occasionally appears clear. Various reflexes and cognitive distancing occur from fandoms when football club ownership engages in practices that, according to the normative models that fans ascribe to their clubs, are mutually exclusive with the values of the fanbase and the club’s history. A common form of fan reflex often takes the form of distancing the players on the pitch from the club’s institutional structures, effectively teasing out the matchday experience from the structures that benefit from the raw emotion it generates. Another reflex is questioning why the fan should surrender their club when a morally, ethically problematic ownership model has acquired it. Here we have perhaps the greatest challenge to the normative model and, rather than negotiating that tension, as often as not the response is to try and ignore it.

This study aims to address this need. In the UK, people with dementia admitted to National Health Service mental health in-patient dementia assessment wards [dementia assessment wards] present as complex and experience a number of changed behaviours, such as excessive walking, agitation and aggression. The complexity of the presentation of dementia has been identified as underpinning pre-and post-admission to these care environments, but limited study has so far been conducted to explore the boundaries and meaning of complexity and its relationship to dementia assessment ward practice.

An online electronic survey of UK-based national dementia leaders was conducted in 2018. Nineteen completed questionnaires were returned, and mental health nurses comprised the largest sub-sample. Qualitative data of the free-text responses were analysed using manifest content analysis.

Four routes to admission to a dementia assessment ward were identified. Multiplicity of needs and interconnectedness were seen as important domains in uncovering the meaning of complexity. The importance of life story and formulation approaches were highlighted. Challenges uncovered included, better understanding changed behaviour and its relationship to complexity, the need for understanding the boundaries of complexity and making visible care practices on these specific wards.

Findings can be used to produce a heightened awareness about the meaning and function of complexity in dementia assessment wards. Policymakers and researchers need to increase the emphasis on this area of mental health and dementia care. Further training for the multidisciplinary team on formulation approaches could help to improve the evidence-base for practice.

The purpose of this paper is to describe a case study to test the applicability of the discrete choice experiment (DCE) method to assess the preferences of carers of people with dementia. The focus of enquiry was home care provision.

A multi-method approach was adopted for this pilot study. A literature review identified key characteristics of home care for dementia. This informed consultations with lay representatives. Key attributes of home care for the DCE were identified and formed the basis for the schedule. In all, 28 carers were recruited by two voluntary organisations to complete the DCE. A multinomial logistic regression model was used to analyse the data.

Seven attributes of home care for people with dementia were identified from the consultation. The use of the DCE approach permitted the identification of those most important to carers. Despite the modest sample, statistically significant findings were reported in relation to five of the attributes indicating their relevance. A lay involvement in the identification of attributes contributed to the ease of administration of the schedule and relevance of the findings.

This study demonstrated the utility of a DCE to capture the preferences of carers of people with dementia and thereby gather information from carers to inform policy, practice and service development. Their involvement in the design of the schedule was critical to this process.

A growing ageing population with complex healthcare needs is a challenge to the organisation of healthcare support for older people residing in care homes. The lack of specialised healthcare support for care home residents has resulted in poorer outcomes, compared with community-dwelling older people. However, little is known about the forms, staff mix, organisation and delivery of such services for residents’ physical healthcare needs. The paper aims to discuss these issues.

This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aimed to provide an overview of the range of healthcare services delivered to care homes and to identify core features of variation in their organisation, activities and responsibilities. The eligibility criteria for studies were services designed to address the physical healthcare needs of older people, permanently residing in care homes, with or without nursing. To search the literature, terms relating to care homes, healthcare and older people, across ten electronic databases were used. The quality of service descriptions was appraised using a rating tool designed for the study. The evidence was synthesised, by means of a narrative summary, according to key areas of variation, into models of healthcare support with examples of their relative effectiveness.

In total, 84 studies, covering 74 interventions, identified a diverse range of specialist healthcare support services, suggesting a wide variety of ways of delivering healthcare support to care homes. These fell within five models: assessment – no consultant; assessment with consultant; assessment/management – no consultant; assessment/management with consultant; and training and support. The predominant model offered a combination of assessment and management. Overall, there was a lack of detail in the data, making judgements of relative effectiveness difficult. Recommendations for future research include the need for clearer descriptions of interventions and particularly of data on resident-level costs and effectiveness, as well as better explanations of how services are implemented (review registration: PROSPERO CRD42017081161).

There is considerable debate about the best means of providing healthcare to older people in care homes. A number of specialist initiatives have developed and this review seeks to bring these together in a comparative approach deriving models of care of value to policy makers and commissioners.

The Outlook project based in Manchester offers a range of activities, support and skills training to people over the age of 17 with ongoing or previous drug or alcohol issues. The programme was originally implemented in 2002 in response to identified need for a comprehensive dedicated outreach service to cater for the diverse needs of problematic drug and alcohol users across the east Manchester area (Iredale, 2002). The catchment area for service users has since been extended to include the rest of Manchester city centre (ONS census 2003 estimates that the Manchester city area has a population of approximately 432,400 people).The programme is based on a community model, reaching out especially to ‘hard to reach’ groups of local people in many socially excluded areas of Manchester. The indices of Multiple Deprivation show that Manchester has an exceptionally low ranking position in the North West compared with the rest of the UK when accounting for factors of income, employment, education, health, skills and training, barriers to housing and services, and crime.